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Claridge Mackonis E, Stensmyr R, Poldy R, White P, Moutrie Z, Gorjiara T, Seymour E, Erven T, Hardcastle N, Haworth A. Improving motion management in radiation therapy: findings from a workshop and survey in Australia and New Zealand. Phys Eng Sci Med 2024; 47:813-820. [PMID: 38805104 DOI: 10.1007/s13246-024-01405-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/09/2024] [Indexed: 05/29/2024]
Abstract
Motion management has become an integral part of radiation therapy. Multiple approaches to motion management have been reported in the literature. To allow the sharing of experiences on current practice and emerging technology, the University of Sydney and the New South Wales/Australian Capital Territory branch of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) held a two-day motion management workshop. To inform the workshop program, participants were invited to complete a survey prior to the workshop on current use of motion management techniques and their opinion on the effectiveness of each approach. A post-workshop survey was also conducted, designed to capture changes in opinion as a result of workshop participation. The online workshop was the most well attended ever hosted by the ACPSEM, with over 300 participants and a response to the pre-workshop survey was received from at least 60% of the radiation therapy centres in Australia and New Zealand. Motion management is extensively used in the region with use of deep inspiration breath-hold (DIBH) reported by 98% of centres for left-sided breast treatments and 91% for at least some right-sided breast treatments. Surface guided radiation therapy (SGRT) was the most popular session at the workshop and survey results showed that the use of SGRT is likely to increase. The workshop provided an excellent opportunity for the exchange of knowledge and experience, with most survey respondents indicating that their participation would lead to improvements in the quality of delivery of treatments at their centres.
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Affiliation(s)
| | | | - Rachel Poldy
- Canberra Region Cancer Centre, Canberra, Australia
| | - Paul White
- South Eastern Sydney LHD, Randwick, Australia
| | - Zoë Moutrie
- South Western Sydney Cancer Services, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
| | | | | | - Tania Erven
- South Western Sydney Cancer Services, Sydney, NSW, Australia
| | - Nicholas Hardcastle
- Peter MacCallum Cancer Centres, Melbourne, Australia
- Institute of Medical Physics, University of Sydney, Camperdown, Australia
| | - Annette Haworth
- Institute of Medical Physics, University of Sydney, Camperdown, Australia
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Yoon J, Jung H, Tanny SM, Lemus OMD, Milano MT, Hardy SJ, Usuki KY, Zheng D. A comprehensive evaluation of advanced dose calculation algorithms for brain stereotactic radiosurgery. J Appl Clin Med Phys 2023; 24:e14169. [PMID: 37775989 PMCID: PMC10647955 DOI: 10.1002/acm2.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE Accurate dose calculation is important in both target and low dose normal tissue regions for brain stereotactic radiosurgery (SRS). In this study, we aim to evaluate the dosimetric accuracy of the two advanced dose calculation algorithms for brain SRS. METHODS Retrospective clinical case study and phantom study were performed. For the clinical study, 138 SRS patient plans (443 targets) were generated using BrainLab Elements Voxel Monte Carlo (VMC). To evaluate the dose calculation accuracy, the plans were exported into Eclipse and recalculated with Acuros XB (AXB) algorithm with identical beam parameters. The calculated dose at the target center (Dref), dose to 95% target volume (D95), and the average dose to target (Dmean) were compared. Also, the distance from the skull was analyzed. For the phantom study, a cylindrical phantom and a head phantom were used, and the delivered dose was measured by an ion chamber and EBT3 film, respectively, at various locations. The measurement was compared with the calculated doses from VMC and AXB. RESULTS In clinical cases, VMC dose calculations tended to be higher than AXB. It was found that the difference in Dref showed > 5% in some cases for smaller volumes < 0.3 cm3 . Dmean and D95 differences were also higher for small targets. No obvious trend was found between the dose difference and the distance from the skull. In phantom studies, VMC dose was also higher than AXB for smaller targets, and VMC showed better agreement with the measurements than AXB for both point dose and high dose spread. CONCLUSION The two advanced calculation algorithms were extensively compared. For brain SRS, AXB sometimes calculates a noticeable lower target dose for small targets than VMC, and VMC tends to have a slightly closer agreement with measurements than AXB.
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Affiliation(s)
- Jihyung Yoon
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Hyunuk Jung
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sean M. Tanny
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Olga Maria Dona Lemus
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Michael T. Milano
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Sara J. Hardy
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Kenneth Y. Usuki
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Dandan Zheng
- Department of Radiation OncologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
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Ge X, Yang M, Li T, Liu T, Gao X, Qiu Q, Yin Y. Comparative analysis of dose calculation algorithms for CyberKnife-based stereotactic radiotherapy in lung cancer. Front Oncol 2023; 13:1215976. [PMID: 37849803 PMCID: PMC10577380 DOI: 10.3389/fonc.2023.1215976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
Purpose The accuracy of dose calculation is the prerequisite for CyberKnife (CK) to implement precise stereotactic body radiotherapy (SBRT). In this study, CK-MLC treatment planning for early-stage non-small cell lung cancer (NSCLC) were compared using finite-size pencil beam (FSPB) algorithm, FSPB with lateral scaling option (FSPB_LS) and Monte Carlo (MC) algorithms, respectively. We concentrated on the enhancement of accuracy with the FSPB_LS algorithm over the conventional FSPB algorithm and the dose consistency with the MC algorithm. Methods In this study, 54 cases of NSCLC were subdivided into central lung cancer (CLC, n=26) and ultra-central lung cancer (UCLC, n=28). For each patient, we used the FSPB algorithm to generate a treatment plan. Then the dose was recalculated using FSPB_LS and MC dose algorithms based on the plans computed using the FSPB algorithm. The resultant plans were assessed by calculating the mean value of pertinent comparative parameters, including PTV prescription isodose, conformity index (CI), homogeneity index (HI), and dose-volume statistics of organs at risk (OARs). Results In this study, most dose parameters of PTV and OARs demonstrated a trend of MC > FSPB_LS > FSPB. The FSPB_LS algorithm aligns better with the dose parameters of the target compared to the MC algorithm, which is particularly evident in UCLC. However, the FSPB algorithm significantly underestimated the does of the target. Regarding the OARs in CLC, differences in dose parameters were observed between FSPB and FSPB_LS for V10 of the contralateral lung, as well as between FSPB and MC for mean dose (Dmean) of the contralateral lung and maximum dose (Dmax) of the aorta, exhibiting statistical differences. There were no statistically significant differences observed between FSPB_LS and MC for the OARs. However, the average dose deviation between FSPB_LS and MC algorithms for OARs ranged from 2.79% to 11.93%. No significant dose differences were observed among the three algorithms in UCLC. Conclusion For CLC, the FSPB_LS algorithm exhibited good consistency with the MC algorithm in PTV and demonstrated a significant improvement in accuracy when compared to the traditional FSPB algorithm. However, the FSPB_LS algorithm and the MC algorithm showed a significant dose deviation in OARs of CLC. In the case of UCLC, FSPB_LS showed better consistency with the MC algorithm than observed in CLC. Notwithstanding, UCLC's OARs were highly sensitive to radiation dose and could result in potentially serious adverse reactions. Consequently, it is advisable to use the MC algorithm for dose calculation in both CLC and UCLC, while the application of FSPB_LS algorithm should be carefully considered.
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Affiliation(s)
- Xuanchu Ge
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Mingshan Yang
- Department of Urology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tengxiang Li
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tonghai Liu
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiangyu Gao
- Department of Radiation Oncology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingtao Qiu
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Peschel DP, Düsberg M, Peeken JC, Kaiser JC, Borm KJ, Sommer K, Combs SE, Münch S. Incidental nodal irradiation in patients with esophageal cancer undergoing (chemo)radiation with 3D-CRT or VMAT. Sci Rep 2022; 12:22333. [PMID: 36567356 PMCID: PMC9790887 DOI: 10.1038/s41598-022-26641-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
The extent of elective nodal irradiation (ENI) in patients undergoing definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of this dosimetric study was to evaluate the extent of incidental nodal irradiation using modern radiation techniques. A planning target volume (PTV) was generated for 30 patients with node-negative esophageal carcinoma (13 cervical/upper third, 7 middle third, 10 lower third/abdomen). Thereby, no elective nodal irradiation (ENI) was intended. Both three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT) treatment plans (50 Gy in 25 fractions) were calculated for all patients. Fifteen nodal stations were contoured according to the definitions of the AJCC and investigated in regard to dosimetric parameters. Compared to 3D-CRT, VMAT was associated with lower dose distribution to the organs at risk (lower Dmean, V20 and V30 for the lungs and lower Dmean and V30 for the heart). For both techniques, the median Dmean surpassed 40 Gy in 12 of 15 (80%) nodal stations. However, VMAT resulted in significantly lower Dmeans and equivalent uniform doses (EUD) compared to 3D-CRT for eight nodal stations (1L, 2L, 2R, 4L, 7, 8L, 10L, 15), while differences did not reach significance for seven nodal station (1R, 4R, 8U, 8M, 10R, 16). For dCRT of ESCC, the use of VMAT was associated with significantly lower median (incidental) doses to eight of 15 regional lymph node areas compared to 3D-CRT. However, given the small absolute differences, these differences probably do not impair (regional) tumor control rates.
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Affiliation(s)
- David Paul Peschel
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jan Christian Kaiser
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Kai Joachim Borm
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Katharina Sommer
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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Abstract
We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic metastases. The recommendations for delineation of the target volumes and critical organs are detailed.
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Affiliation(s)
- A Lévy
- Département d'oncologie radiothérapie, Gustave-Roussy, 94805 Villejuif, France; Université Paris-Saclay, Inserm U1030, radiothérapie moléculaire, 94805, Villejuif, France; Faculté de médecine, université Paris-Saclay, 94270 Le Kremlin-Bicêtre, France.
| | - J Darréon
- Département d'oncologie radiothérapie, institut Paoli-Calmettes, 13000 Marseille, France; CRCM Inserm U1068, 13000 Marseille, France
| | - F Mornex
- Département d'oncologie radiothérapie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EMR 3738, université Claude-Bernard Lyon1, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - P Giraud
- Service d'oncologie radiothérapie, hôpital européen-Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - S Thureau
- Département de d'oncologie radiothérapie, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; QuantIf Litis EA4108, université de Rouen, 76000 Rouen, France
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Savanović M, Jaroš D, Foulquier JN. Planning target volume density impact on treatment planning for lung stereotactic body radiation therapy. Acta Oncol 2021; 60:1296-1300. [PMID: 34259116 DOI: 10.1080/0284186x.2021.1950926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND To evaluate the impact of the planning target volume (PTV) density on treatment planning for lung Stereotactic Body Radiation Therapy (SBRT). MATERIAL AND METHODS The PTV coverage was analyzed in two groups of 40 lung SBRT patients. One group had PTV density <0.5 g/cm3, while the other group had PTV density >0.5 g/cm3. The treatments were planned in Pinnacle 9.10, using the collapsed cone convolution (CCC) algorithm. The prescribed dose was 60 Gy to the PTV in 4-8 fractions. Respecting constraint for the PTV coverage (D98% > 95%), we compared changes in the isodose line prescription, the number of monitor units (MU), maximum dose (Dmax), irradiated volume covered with 30 Gy (V30Gy), and the optimization planning volume (OPV). RESULTS For the same median values of the PTV coverage (98.3%), the differences are presented with median values between lower and higher density than 0.5 g/cm3. The isodose line prescription was 83 vs. 90% (p < 0.0001), the MUs were 2294 vs. 1655 MU (p < 0.0001), Dmax was 74.26 vs. 68.09 Gy (p < 0.0001), V30Gy was 117.03 vs. 104.81 cc (p = 0.04), and OPV was 28.48 vs. 39.35 cc (p < 0.001). By overriding the ITV density to 0.8 g/cm3, the isodose line prescription decreases. The Dmax and MUs decrease by 7%, V30Gy by 34%, and OPV by 70%. CONCLUSION To obtain similar PTV coverage for PTV which is <0.5 g/cm3, a larger margin irradiating a large OPV was used. More MUs and a higher maximum dose were delivered. For the PTV density of ≤0.36 g/cm3, overriding is recommended to reduce the dose and irradiated volume.
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Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Dražan Jaroš
- Center for Radiotherapy, International Medical Centers, Affidea, Banja Luka, Bosnia and Herzegovina
| | - Jean-Noël Foulquier
- Department of Radiation Oncology, Tenon Hospital, APHP, Sorbonne University, Paris, France
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Dose Calculation Algorithms for External Radiation Therapy: An Overview for Practitioners. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156806] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiation therapy (RT) is a constantly evolving therapeutic technique; improvements are continuously being introduced for both methodological and practical aspects. Among the features that have undergone a huge evolution in recent decades, dose calculation algorithms are still rapidly changing. This process is propelled by the awareness that the agreement between the delivered and calculated doses is of paramount relevance in RT, since it could largely affect clinical outcomes. The aim of this work is to provide an overall picture of the main dose calculation algorithms currently used in RT, summarizing their underlying physical models and mathematical bases, and highlighting their strengths and weaknesses, referring to the most recent studies on algorithm comparisons. This handy guide is meant to provide a clear and concise overview of the topic, which will prove useful in helping clinical medical physicists to perform their responsibilities more effectively and efficiently, increasing patient benefits and improving the overall quality of the management of radiation treatment.
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Muñoz-Montplet C, Fuentes-Raspall R, Jurado-Bruggeman D, Agramunt-Chaler S, Onsès-Segarra A, Buxó M. Dosimetric Impact of Acuros XB Dose-to-Water and Dose-to-Medium Reporting Modes on Lung Stereotactic Body Radiation Therapy and Its Dependency on Structure Composition. Adv Radiat Oncol 2021; 6:100722. [PMID: 34258473 PMCID: PMC8256186 DOI: 10.1016/j.adro.2021.100722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Our purpose was to assess the dosimetric effect of switching from the analytical anisotropic algorithm (AAA) to Acuros XB (AXB), with dose-to-medium (Dm) and dose-to-water (Dw) reporting modes, in lung stereotactic body radiation therapy patients and determine whether planning-target-volume (PTV) dose prescriptions and organ-at-risk constraints should be modified under these circumstances. Methods and Materials We included 54 lung stereotactic body radiation therapy patients. We delineated the PTV, the ipsilateral lung, the contralateral lung, the heart, the spinal cord, the esophagus, the trachea, proximal bronchi, the ribs, and the great vessels. We performed dose calculations with AAA and AXB, then compared clinically relevant dose-volume parameters. Paired t tests were used to analyze differences of means. We propose a method, based on the composition of the involved structures, for predicting differences between AXB Dw and Dm calculations. Results The largest difference between the algorithms was 4%. Mean dose differences between AXB Dm and AXB Dw depended on the average composition of the volumes. Compared with AXB, AAA underestimated all PTV dose-volume parameters (-0.7 Gy to -0.1 Gy) except for gradient index, which was significantly higher (4%). It also underestimated V5 of the contralateral lung (-0.3%). Significant differences in near-maximum doses (D2) to the ribs were observed between AXB Dm and AAA (1.7%) and between AXB Dw and AAA (-1.6%). AAA-calculated D2 was slightly higher in the remaining organs at risk. Conclusions Differences between AXB and AAA are below the threshold of clinical detectability (5%) for most patients. For a small subgroup, the difference in maximum doses to the ribs between AXB Dw and AXB Dm may be clinically significant. The differences in dose volume parameters between AXB Dw and AXB Dm can be predicted with reference to structure composition.
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Affiliation(s)
- Carles Muñoz-Montplet
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Avda. França s/n, 17007 Girona, Spain.,Department of Medical Sciences, University of Girona, C/Emili Grahit 77, 17003 Girona, Spain
| | - Rafael Fuentes-Raspall
- Department of Medical Sciences, University of Girona, C/Emili Grahit 77, 17003 Girona, Spain.,Radiation Oncology Department, Institut Català d'Oncologia, Avda. França s/n, 17007 Girona, Spain
| | - Diego Jurado-Bruggeman
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Avda. França s/n, 17007 Girona, Spain
| | - Sebastià Agramunt-Chaler
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Avda. França s/n, 17007 Girona, Spain
| | - Albert Onsès-Segarra
- Medical Physics and Radiation Protection Department, Institut Català d'Oncologia, Avda. França s/n, 17007 Girona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí i Julià, Edifici M2, 17190, Salt, Spain
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Mohatt DJ, Ma T, Wiant DB, Islam NM, Gomez J, Singh AK, Malhotra HK. Technical and dosimetric implications of respiratory induced density variations in a heterogeneous lung phantom. Radiat Oncol 2018; 13:165. [PMID: 30180894 PMCID: PMC6124019 DOI: 10.1186/s13014-018-1110-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic Body Radiotherapy (SBRT) is an ablative dose delivery technique which requires the highest levels of precision and accuracy. Modeling dose to a lung treatment volume has remained a complex and challenging endeavor due to target motion and the low density of the surrounding media. When coupled together, these factors give rise to pulmonary induced tissue heterogeneities which can lead to inaccuracies in dose computation. This investigation aims to determine which combination of imaging techniques and computational algorithms best compensates for time dependent lung target displacements. METHODS A Quasar phantom was employed to simulate respiratory motion for target ranges up to 3 cm. 4DCT imaging was used to generate Average Intensity Projection (AIP), Free Breathing (FB), and Maximum Intensity Projection (MIP) image sets. In addition, we introduce and compare a fourth dataset for dose computation based on a novel phase weighted density (PWD) technique. All plans were created using Eclipse version 13.6 treatment planning system and calculated using the Analytical Anisotropic Algorithm and Acuros XB. Dose delivery was performed using Truebeam STx linear accelerator where radiochromic film measurements were accessed using gamma analysis to compare planned versus delivered dose. RESULTS In the most extreme case scenario, the mean CT difference between FB and MIP datasets was found to be greater than 200 HU. The near maximum dose discrepancies between AAA and AXB algorithms were determined to be marginal (< 2.2%), with a greater variability occurring within the near minimum dose regime (< 7%). Radiochromatic film verification demonstrated all AIP and FB based computations exceeded 98% passing rates under conventional radiotherapy tolerances (gamma 3%, 3 mm). Under more stringent SBRT tolerances (gamma 3%, 1 mm), the AIP and FB based treatment plans exhibited higher pass rates (> 85%) when compared to MIP and PWD (< 85%) for AAA computations. For AXB, however, the delivery accuracy for all datasets were greater than 85% (gamma 3%,1 mm), with a corresponding reduction in overall lung irradiation. CONCLUSIONS Despite the substantial density variations between computational datasets over an extensive range of target movement, the dose difference between CT datasets is small and could not be quantified with ion chamber. Radiochromatic film analysis suggests the optimal CT dataset is dependent on the dose algorithm used for evaluation. With AAA, AIP and FB resulted in the best conformance between measured versus calculated dose for target motion ranging up to 3 cm under both conventional and SBRT tolerance criteria. With AXB, pass rates improved for all datasets with the PWD technique demonstrating slightly better conformity over AIP and FB based computations (gamma 3%, 1 mm). As verified in previous studies, our results confirm a clear advantage in delivery accuracy along with a relative decrease in calculated dose to the lung when using Acuros XB over AAA.
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Affiliation(s)
- Dennis J Mohatt
- Medical Physics Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14214-3005, USA. .,Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA.
| | - Tianjun Ma
- Medical Physics Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14214-3005, USA.,Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA
| | - David B Wiant
- Radiation Oncology, Cone Health Cancer Center, Greensboro, NC, 27403, USA
| | - Naveed M Islam
- Medical Physics Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14214-3005, USA.,Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA
| | - Jorge Gomez
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA
| | - Harish K Malhotra
- Medical Physics Program, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, 14214-3005, USA.,Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, 14293, USA
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10
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Soh RCX, Tay GH, Lew WS, Lee JCL. A depth dose study between AAA and AXB algorithm against Monte Carlo simulation using AIP CT of a 4D dataset from a moving phantom. Rep Pract Oncol Radiother 2018; 23:413-424. [PMID: 30197577 DOI: 10.1016/j.rpor.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 05/15/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
Abstract
Aim To identifying depth dose differences between the two versions of the algorithms using AIP CT of a 4D dataset. Background Motion due to respiration may challenge dose prediction of dose calculation algorithms during treatment planning. Materials and methods The two versions of depth dose calculation algorithms, namely, Anisotropic Analytical Algorithm (AAA) version 10.0 (AAAv10.0), AAA version 13.6 (AAAv13.6) and Acuros XB dose calculation (AXB) algorithm version 10.0 (AXBv10.0), AXB version 13.6 (AXBv13.6), were compared against a full MC simulated 6X photon beam using QUASAR respiratory motion phantom with a moving chest wall. To simulate the moving chest wall, a 4 cm thick wax mould was attached to the lung insert of the phantom. Depth doses along the central axis were compared in the anterior and lateral beam direction for field sizes 2 × 2 cm2, 4 × 4 cm2 and 10 × 10 cm2. Results For the lateral beam direction, the moving chest wall highlighted differences of up to 105% for AAAv10.0 and 40% for AXBv10.0 from MC calculations in the surface and buildup doses. AAAv13.6 and AXBv13.6 agrees with MC predictions to within 10% at similar depth. For anterior beam doses, dose differences predicted for both versions of AAA and AXB algorithm were within 7% and results were consistent with static heterogeneous studies. Conclusions The presence of the moving chest wall was capable of identifying depth dose differences between the two versions of the algorithms. These differences could not be identified in the static chest wall as shown in the anterior beam depth dose calculations.
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Affiliation(s)
- Roger Cai Xiang Soh
- Department of Radiation Oncology, National University Cancer Institute, Singapore.,Division of Physics and Applied Physics, Nanyang Technological University, Singapore
| | - Guan Heng Tay
- Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Wen Siang Lew
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore
| | - James Cheow Lei Lee
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore.,Division of Radiation Oncology, National Cancer Centre, Singapore
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11
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Liang X, Zheng D, Mamalui-Hunter M, Flampouri S, Hoppe BS, Mendenhall N, Li Z. ITV-Based Robust Optimization for VMAT Planning of Stereotactic Body Radiation Therapy of Lung Cancer. Pract Radiat Oncol 2018; 9:38-48. [PMID: 30138747 DOI: 10.1016/j.prro.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Using planning target volume (PTV) to account for setup uncertainties in stereotactic body radiation therapy (SBRT) of lung cancer has been questioned because a significant portion of the PTV contains low-density lung tissue. The purpose of this study is to (1) investigate the feasibility of using robust optimization to account for setup uncertainties in volumetric modulated arc therapy plan for lung SBRT and (2) evaluate the potential normal tissue-sparing benefit of a robust optimized plan compared with a conventional PTV-based optimized plan. METHODS AND MATERIALS The study was conducted with both phantom and patient cases. For each patient or phantom, 2 SBRT lung volumetric modulated arc therapy plans were generated, including an optimized plan based on the PTV (PTV-based plan) with a 5-mm internal target volume (ITV)-to-PTV margin and a second plan based on robust optimization of ITV (ITV-based plan) with ±5-mm setup uncertainties. The target coverage was evaluated on ITV D99 in 15 scenarios that simulated a 5-mm setup error. Dose-volume information on normal lung tissue, intermediate-to-high dose spillage, and integral dose was evaluated. RESULTS Compared with PTV-based plans, ITV-based robust optimized plans resulted in lower normal lung tissue dose, lower intermediate-to-high dose spillage to the body, and lower integral dose, while preserving the dose coverage under setup error scenarios for both phantom and patient cases. CONCLUSIONS Using ITV-based robust optimization, we have shown that accounting for setup uncertainty in SBRT planning is feasible. Further clinical studies are warranted to confirm the clinical effectiveness of this novel approach.
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Affiliation(s)
- Xiaoying Liang
- Department of Radiation Oncology, University of Florida, Gainesville, Florida.
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Nancy Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
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12
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Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy. Lung Cancer 2018; 117:53-59. [DOI: 10.1016/j.lungcan.2017.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/11/2022]
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13
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Zheng D, Verma V, Wang S, Liang X, Zhou S. Does intensity modulation increase target dose calculation errors of conventional algorithms for lung SBRT? J Appl Clin Med Phys 2018; 19:154-159. [PMID: 29388325 PMCID: PMC5849821 DOI: 10.1002/acm2.12266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose Conventional dose algorithms (Type A and Type B) for lung SBRT can display considerable target dose errors compared to Type‐C algorithms. Intensity‐modulated techniques (IMRT/VMAT) are increasingly being utilized for lung SBRT. Therefore, our study aimed to assess whether intensity modulation increased target dose calculation errors by conventional algorithms over conformal techniques. Methods Twenty lung SBRT patients were parallely planned with both IMRT and dynamic conformal arc (DCA) techniques using a Type‐A algorithm, and another 20 patients were parallely planned with IMRT, VMAT, and DCA using a Type‐B algorithm. All 100 plans were recalculated with Type‐C algorithms using identical beam and monitor unit settings, with the Type‐A/Type‐B algorithm dose errors defined using Type‐C recalculation as the ground truth. Target dose errors for PTV and GTV were calculated for a variety of dosimetric end points. Using Wilcoxon signed‐rank tests (p < 0.05 for statistical significance), target dose errors were compared between corresponding IMRT/VMAT and DCA plans for the two conventional algorithms. The levels of intensity modulation were also evaluated using the ratios of MUs in the IMRT/VMAT plans to those in the corresponding DCA plans. Linear regression was used to study the correlation between intensity modulation and relative dose error magnitudes. Results Overall, larger errors were found for the Type‐A algorithm than for the Type‐B algorithm. However, the IMRT/VMAT plans were not found to have statistically larger dose errors from their corresponding DCA plans. Linear regression did not identify a significant correlation between the intensity modulation level and the relative dose error. Conclusion Intensity modulation did not appear to increase target dose calculation errors for lung SBRT plans calculated with conventional algorithms.
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Affiliation(s)
- Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xiaoying Liang
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Sumin Zhou
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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14
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Botas P, Grassberger C, Sharp G, Paganetti H. Density overwrites of internal tumor volumes in intensity modulated proton therapy plans for mobile lung tumors. Phys Med Biol 2018; 63:035023. [PMID: 29219119 PMCID: PMC5850956 DOI: 10.1088/1361-6560/aaa035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to investigate internal tumor volume density overwrite strategies to minimize intensity modulated proton therapy (IMPT) plan degradation of mobile lung tumors. Four planning paradigms were compared for nine lung cancer patients. Internal gross tumor volume (IGTV) and internal clinical target volume (ICTV) structures were defined encompassing their respective volumes in every 4DCT phase. The paradigms use different planning CT (pCT) created from the average intensity projection (AIP) of the 4DCT, overwriting the density within the IGTV to account for movement. The density overwrites were: (a) constant filling with 100 HU (C100) or (b) 50 HU (C50), (c) maximum intensity projection (MIP) across phases, and (d) water equivalent path length (WEPL) consideration from beam's-eye-view. Plans were created optimizing dose-influence matrices calculated with fast GPU Monte Carlo (MC) simulations in each pCT. Plans were evaluated with MC on the 4DCTs using a model of the beam delivery time structure. Dose accumulation was performed using deformable image registration. Interplay effect was addressed applying 10 times rescanning. Significantly less DVH metrics degradation occurred when using MIP and WEPL approaches. Target coverage ([Formula: see text] Gy(RBE)) was fulfilled in most cases with MIP and WEPL ([Formula: see text] Gy (RBE)), keeping dose heterogeneity low ([Formula: see text] Gy(RBE)). The mean lung dose was kept lowest by the WEPL strategy, as well as the maximum dose to organs at risk (OARs). The impact on dose levels in the heart, spinal cord and esophagus were patient specific. Overall, the WEPL strategy gives the best performance and should be preferred when using a 3D static geometry for lung cancer IMPT treatment planning. Newly available fast MC methods make it possible to handle long simulations based on 4D data sets to perform studies with high accuracy and efficiency, even prior to individual treatment planning.
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Affiliation(s)
- Pablo Botas
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America. University of Heidelberg, Department of Physics, Heidelberg, Germany
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15
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Zhou C, Bennion N, Ma R, Liang X, Wang S, Zvolanek K, Hyun M, Li X, Zhou S, Zhen W, Lin C, Wahl A, Zheng D. A comprehensive dosimetric study on switching from a Type-B to a Type-C dose algorithm for modern lung SBRT. Radiat Oncol 2017; 12:80. [PMID: 28476138 PMCID: PMC5420128 DOI: 10.1186/s13014-017-0816-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/01/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Type-C dose algorithms provide more accurate dosimetry for lung SBRT treatment planning. However, because current dosimetric protocols were developed based on conventional algorithms, its applicability for the new generation algorithms needs to be determined. Previous studies on this issue used small sample sizes and reached discordant conclusions. Our study assessed dose calculation of a Type-C algorithm with current dosimetric protocols in a large patient cohort, in order to demonstrate the dosimetric impacts and necessary treatment planning steps of switching from a Type-B to a Type-C dose algorithm for lung SBRT planning. METHODS Fifty-two lung SBRT patients were included, each planned using coplanar VMAT arcs, normalized to D95% = prescription dose using a Type-B algorithm. These were compared against three Type-C plans: re-calculated plans (identical plan parameters), re-normalized plans (D95% = prescription dose), and re-optimized plans. Dosimetric endpoints were extracted and compared among the four plans, including RTOG dosimetric criteria: (R100%, R50%, D2cm, V105%, and lung V20), PTV Dmin, Dmax, Dmean, V% and D90%, PTV coverage (V100%), homogeneity index (HI), and Paddick conformity index (PCI). RESULTS Re-calculated Type-C plans resulted in decreased PTV Dmin with a mean difference of 5.2% and increased Dmax with a mean difference of 3.1%, similar or improved RTOG dose compliance, but compromised PTV coverage (mean D95% and V100% reduction of 2.5 and 8.1%, respectively). Seven plans had >5% D95% reduction (maximum reduction = 16.7%), and 18 plans had >5% V100% reduction (maximum reduction = 60.0%). Re-normalized Type-C plans restored target coverage, but yielded degraded plan conformity (average PCI reduction 4.0%), and RTOG dosimetric criteria deviation worsened in 11 plans, in R50%, D2cm, and R100%. Except for one case, re-optimized Type-C plans restored RTOG compliance achieved by the original Type-B plans, resulting in similar dosimetric values but slightly higher target dose heterogeneity (mean HI increase = 13.2%). CONCLUSIONS Type-B SBRT lung plans considerably overestimate target coverage for some patients, necessitating Type-C re-normalization or re-optimization. Current RTOG dosimetric criteria appear to remain appropriate.
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Affiliation(s)
- Christina Zhou
- School of Biological Sciences, University of Chicago, Chicago, IL USA
| | - Nathan Bennion
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Rongtao Ma
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Xiaoying Liang
- University of Florida Health Proton Therapy Institute, Jacksonville, FL USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Kristina Zvolanek
- Department of Biological Systems Engineering, University of Nebraska Lincoln, Lincoln, NE USA
| | - Megan Hyun
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Xiaobo Li
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian China
| | - Sumin Zhou
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Weining Zhen
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Andrew Wahl
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, 42nd and Emile St, Omaha, NE 68198 USA
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